Provider Demographics
NPI:1093259681
Name:VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Other - Org Name:VPCHC-ROCKVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:765-828-1003
Mailing Address - Street 1:727 N. LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1117
Mailing Address - Country:US
Mailing Address - Phone:765-569-1123
Mailing Address - Fax:765-569-6412
Practice Address - Street 1:727 N. LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1117
Practice Address - Country:US
Practice Address - Phone:765-569-1123
Practice Address - Fax:765-569-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)